With Improvements in geriatric medicine, the elderly live longer. The present study mainly discussed the epidemiological features of burn among the geriatric population at Velayat Burn Center in the north of Iran, from January 2010 to January 2020. Guilan is one of the northern provinces in Iran, with 335,000 elderlies, respectively. The proportion of the elderly in our population is 13%. According to the National Population and Housing Census results in 2016, 2011, and 2006, Guilan has had the oldest population in Iran for the past 15 years (10). This study is different from previous studies because of the following facts: 1No previous studies have ever discussed the epidemiological features of burn injuries in the elderly in Guilan; 2With the most population of the elderly in the whole country, Guilan province is a good target for epidemiological investigations of burn injuries in the geriatric population. 3In this study, we discussed parameters that are more likely to give better views of the pattern of burn in the elderly.
The proportion of the elderly in burn patients was 11%, while in Australia (11), 21.8% of burn patients were above 60, implying that these patients are more referred to ER in developed countries, while in developing countries like Iran, due to neglect, fewer old patients present to the ER. The mean age was higher in our study (72 years vs. 64 and 69 years ) (4, 12), and the most common age group was 60-69 years which was similar to another study (13). Along with the increased life expectancy, the geriatrics work long after retirement because of financial issues, which increases the chances of work-related burn accidents.
While similar to other studies (14–17), women had more burn accidents, most incidents occurred indoors (82.5%). Most burn injuries happened to the married couples who lived with family members and were either housewife, retired, or unemployed. All of the above show the risk of household activities in burn accidents among the elderly. While many parents work long hours, grandparents play an important role in taking care of their grandchildren _ grandmothers prepare meals for the children, and grandfathers take them outside for a walk or to the park_ and the whole scenario increases the chances of burn accidents in the household. With this information, prevention programs can focus on 1educating family members, nurses, maids, and nannies, 2standardizing houses, installing fire alarms, and identifying danger zones like bath, and kitchen, and 3focusing on the awareness of the elderly about fire-related dangers. Similarly, Aboderin et al. (18) discussed that despite the aging population in developing countries, less attention is paid to the elderly, and preventive programs focus more on children.
Our data showed that burn accidents happen more in urban areas, inconsistent with a study in china (19). Cultural changes are a simple explanation; while in the past three decades, many rural young adults have forced their parents to move to urban areas to be close to the city. As they can not afford to live in big apartments, they buy old apartments without the essential standards. This phenomenon has caused devastating changes in the lives of the elderly. As a result, we see more indoor burn accidents in urban areas.
In our study, the dominant burn agent was flames _inconsistent with some studies (4, 20, 21) and similar to some others (12, 22)_ but in survivors, the most common agent was scald that results from the slight dominancy of women, indoor accidents, and age-related medical conditions of the elderly like reduced reaction time, visual impairments, and a limited range of motions. Similar to previous studies (23–25), inhalation injury was a risk factor for poor prognosis in the elderly.
The elderly suffer from comorbidities, and even mild burn injuries can cause complications resulting in hospitalization. This can explain the mean TBSA of 19.70±22.13 %, most of which were between 1-20%, which is inconsistent with similar studies (4, 26, 27).
In our study, the average length of hospital stay was 6.14±6.27 days. This parameter was much shorter than other similar research: 23 days in Egypt (4) and 19.6±25.3 days in the USA (28). As previously mentioned in Table-4, the two most essential factors on LOS were higher TBSA and the female sex. Patients with minor injuries left the hospital during the early days of admission, and patients with severe injuries expired during their early days of admission.
One of the most important things that makes the geriatric different from other age groups is medical conditions. In our study, the most common pre-injury medical condition was cardiovascular diseases, and the second was metabolic diseases. Similar to our study, Wang et al. (22) found that the most common morbidity was hypertension. According to previous studies (29), pre-injury morbidities can cause longer hospital days, more surgeries, and worse outcomes. Prolonged reaction time due to heart malfunction and a reduced sense of touch because of neuropathies in diabetic patients can result in severe burn injuries. Educating diabetics and cardiovascular patients, and explaining their vulnerability to simple burn injuries, can help reduce the incidence.
According to the results of previous studies (8, 11, 30–32), the average mortality rate of geriatric burn patients is 15-20%, respectively which is near to the reported mortality rate in our study (15.03%). The mortality rate was related to the age range of the patients (p<0.001), and it raised with age, as reported in previous studies (32, 33). In common with another study (24), there was no significant difference between male and female patients regarding the mortality rate (p=0.256). The least mortality rate was in patients who had amniotic graft as a surgical treatment for their burn injuries. The mortality rate was affected by the anatomical site of the burn injury (p<0.001), and it was the highest in patients with burns in the whole body and trunk, reported as 65.2% and 16.3%, respectively. According to the statistics, age, TBSA, and LOS varied significantly between survivors and non-survivors.
The limitations in our study are: Considering the retrospective nature of this study, we could not collect the information of all the geriatric burn patients because of the lack of data and paper-based records. The elderly who died from a burn injury before reaching the hospital, those treated in private medical centers, and the ones who left our burn center against medical advice were excluded from the study. This study was the first epidemiological investigation of burn among the elderly in Guilan, a northern province in Iran with the oldest population in the whole country. The more we know about the pattern of burn among the geriatric population, the more we can manage prevention programs and reduce the number of burn patients among the delicate group of the elderly.